Patterned androgenic alopecia in normal women

Abstract

‘Patterned’ hair loss of the so-called male type (androgenic alopecia) has long been regarded as a marker of pathological virilization when it occurs in women—an indicator of specific ovarian or adrenal disease. We have believed for many years that patterning is relatively common in normal women, although it is generally masked by the hair styles adopted to convey an appearance of dense hair. Since it is medically important to confirm the physiological nature of female patterning, we carried out a population survey of 564 normal women. The hair density of each subject was carefully examined from above and the hair style flattened or wetted to show the vertex pattern, using the standard grading methods of Hamilton and Ludwig. Thirteen per cent of premenopausal and 37% of post-menopausal women had detectable Hamilton grades of 2–7 which were not obvious from frontal viewing. We conclude that in the absence of other signs of virilization, patterned alopecia in women is a poor indicator of significant androgen metabolism diseases.